Arthroplasty Versus Internal Fixation for Undisplaced Femoral Neck Fracture

NCT ID: NCT04075461

Last Updated: 2025-03-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

330 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-02-01

Study Completion Date

2025-01-26

Brief Summary

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This is the world's first national orthopedic randomized controlled trial (RCT) involving 19 out of 21 departments in Denmark. Each year, 7,000 patients suffer a hip fracture. This is a severe condition leading to 25% mortality after 1 year and 40% do not recover to the same functional level. The aim is to compare two surgical treatment methods (metal fixation versus artificial hip) in patients above 65 years with an undisplaced femoral neck fracture. The hypothesis is that even though an artificial hip is a larger surgical procedure than metal fixation of the broken bone, the artificial hip is more stable with less pain due the lack of a healing broken bone and therefore leads to a better and quicker mobilization after surgery. Better mobilization is one of the most important factors for decreasing mortality. We have chosen a pragmatic RCT design by using the local departmental implants. We hope that the knowledge from this study will therefore easily be implemented afterwards.

Detailed Description

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This is the world's first national orthopedic randomized controlled trial (RCT) involving 20 out of 21 departments in Denmark. The aim is to compare two surgical treatment methods (internal fixation (IF) versus arthroplasty) in patients above 65 years with an undisplaced femoral neck fracture (FNF).

Each year, 7,000 patients suffer a hip fracture. This is a severe condition leading to 25% mortality after 1 year and 40% do not recover to the same functional level. Undisplaced FNF is treated with internal fixation in order to aid in fracture healing. However, approximately 10% in Denmark will suffer a reoperation and two RCT's have demonstrated 20-21% reoperations. In comparison, the reoperation frequency was 5-7% for arthroplasty that also demonstrated slightly faster mobilization which is one of the most important factors for decreasing mortality. The hypothesis is therefore that even though arthroplasty is a larger surgery they benefit from the lack of fracture healing, less pain and faster mobilization.

Patients are included in the emergency department and are electronically randomized to either IF or arthroplasty before the surgery. The design is a pragmatic RCT using the implants which are available in the departments. Furthermore, the postoperative treatment protocol is "business as usual" thereby investigating the precise effect of the intervention in real clinical conditions. In addition to a great external validity this allows for easy implemented after study results. The primary outcome is a validated functional score 1 year after surgery and the sample size is calculated to 330 patients. Secondary outcome measures are additional functional assessments and questionnaires, health related quality of life and pain assessment.

We have set up a steering committee consisting of researchers and senior surgeons with a representative from each region. In addition, all but 1 hospital has a representative in project group. The project is therefore anchored in the entire Denmark.

Conditions

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Undisplaced Fracture Femoral Neck Fractures Internal Fixation; Complications Arthroplasty Complications

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The study is designed as a national pragmatical RCT including all patients with an undisplaced FNF and a NMS score of 5 and above. The standard treatment in Denmark is internal fixation and the patients are randomized to arthroplasty or IF. The steering group have assessed the pragmatic attitude of the design and the study reaches 5 points in 7 of the 9 domains (Figure 1) (9). Reporting is performed accordingly to the extension of the CONSORT statements for pragmatical RCT (17). Using the PRECIS-2 we scored the study to 43 points out of 45 possible.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The surgeon, theater staff and patient cannot be blinded due to the nature of two very different types of surgery. However, the assessors will be blinded for type of surgery.

Study Groups

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Undisplaced FNF + Arthroplasty

Arthroplasty is the typical surgery for a displaced femoral neck fracture

Group Type EXPERIMENTAL

Arthroplasty

Intervention Type PROCEDURE

Arthroplasty is commonly used for a displaced femoral neck fracture.

Undisplaced FNF + Internal fixation

Internal fixation is the typical surgery for an undisplaced femoral neck fracture

Group Type ACTIVE_COMPARATOR

Internal fixation

Intervention Type PROCEDURE

Internal fixation is commonly used for undisplaced femoral neck fracture

Interventions

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Arthroplasty

Arthroplasty is commonly used for a displaced femoral neck fracture.

Intervention Type PROCEDURE

Internal fixation

Internal fixation is commonly used for undisplaced femoral neck fracture

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Age ≥ 65 years old
* Undisplaced femoral neck fracture
* Posterior tilt (18) less than 20 degrees
* NMS (13) = 5 and above, indicating an ability to walk
* Cognitive intact in order to achieve informed consent

Exclusion Criteria

* The fracture is pathological
* The patient does not speak Danish
Minimum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Aalborg University Hospital

OTHER

Sponsor Role collaborator

Regionshospital Nordjylland

OTHER_GOV

Sponsor Role collaborator

Aarhus University Hospital

OTHER

Sponsor Role collaborator

Odense University Hospital

OTHER

Sponsor Role collaborator

Slagelse Hospital

OTHER

Sponsor Role collaborator

Bispebjerg Hospital

OTHER

Sponsor Role collaborator

Regionshospitalet Viborg, Skive

OTHER

Sponsor Role collaborator

Randers Regional Hospital

OTHER

Sponsor Role collaborator

Regionshospitalet Horsens

OTHER

Sponsor Role collaborator

Hospital of Southern Jutland

OTHER

Sponsor Role collaborator

Esbjerg Hospital - University Hospital of Southern Denmark

OTHER

Sponsor Role collaborator

Hvidovre University Hospital

OTHER

Sponsor Role collaborator

Herlev Hospital

OTHER

Sponsor Role collaborator

Hillerod Hospital, Denmark

OTHER

Sponsor Role collaborator

Holbaek Sygehus

OTHER

Sponsor Role collaborator

Zealand University Hospital

OTHER

Sponsor Role collaborator

Sygehus Lillebaelt

OTHER

Sponsor Role collaborator

Nykøbing Falster County Hospital

OTHER

Sponsor Role collaborator

Regional Hospital West Jutland

OTHER

Sponsor Role collaborator

Bornholm Hospital

UNKNOWN

Sponsor Role collaborator

University of Southern Denmark

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Bjarke Viberg, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Department of Orthopaedic Surgery and Traumatology, Lillebaelt Hospital

Ole Brink, MD, PhD

Role: STUDY_CHAIR

Department of Orthopaedic Surgery and Traumatology, Aarhus University Hospital

Søren Kold, Professor

Role: STUDY_CHAIR

Department of Orthopaedic Surgery and Traumatology, Aalborg University Hospital

Morten S Larsen, MD

Role: STUDY_CHAIR

Odense University Hospital

Kristoffer B Hare, MD, PhD

Role: STUDY_CHAIR

Department of Orthopaedic Surgery and Traumatology, Slagelse Hospital

Henrik Palm, MD, DmSc

Role: STUDY_CHAIR

Department of Orthopaedic Surgery and Traumatology, Bispebjerg Hospital

Locations

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Hospital of Southern Jutland

Aabenraa, , Denmark

Site Status

Aalborg University Hospital

Aalborg, , Denmark

Site Status

Aarhus University Hospital

Aarhus, , Denmark

Site Status

Bispebjerg Hospital

Copenhagen, , Denmark

Site Status

Herlev Hospital

Copenhagen, , Denmark

Site Status

Hvidovre Hospital

Copenhagen, , Denmark

Site Status

Regional Hospital West Jutland

Gødstrup, , Denmark

Site Status

Hospital of North Zealand

Hillerød, , Denmark

Site Status

North Denmark Regional Hospital

Hjørring, , Denmark

Site Status

Holbæk Hospital

Holbæk, , Denmark

Site Status

Randers Regional Hospital

Horsens, , Denmark

Site Status

Lillebaelt Hospital

Kolding, , Denmark

Site Status

Zealand University Hospital

Køge, , Denmark

Site Status

Nykøbing Falster Hospital

Nykøbing Falster, , Denmark

Site Status

Odense University Hospital

Odense, , Denmark

Site Status

Randers Regional Hospital

Randers, , Denmark

Site Status

Bornholm Hospital

Rønne, , Denmark

Site Status

Slagelse Hospital

Slagelse, , Denmark

Site Status

Viborg Regional Hospital

Viborg, , Denmark

Site Status

Countries

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Denmark

References

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National Institute for Health and Care Excellence. Hip fracture: mangement. Clinical guideline [CG124]. National Institute for Health and Care Excellence; 2011, updated 2017.

Reference Type BACKGROUND

Roberts KC, Brox WT, Jevsevar DS, Sevarino K. Management of hip fractures in the elderly. J Am Acad Orthop Surg. 2015 Feb;23(2):131-7. doi: 10.5435/JAAOS-D-14-00432.

Reference Type BACKGROUND
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Lu Q, Tang G, Zhao X, Guo S, Cai B, Li Q. Hemiarthroplasty versus internal fixation in super-aged patients with undisplaced femoral neck fractures: a 5-year follow-up of randomized controlled trial. Arch Orthop Trauma Surg. 2017 Jan;137(1):27-35. doi: 10.1007/s00402-016-2591-9. Epub 2016 Nov 11.

Reference Type BACKGROUND
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Dolatowski FC, Frihagen F, Bartels S, Opland V, Saltyte Benth J, Talsnes O, Hoelsbrekken SE, Utvag SE. Screw Fixation Versus Hemiarthroplasty for Nondisplaced Femoral Neck Fractures in Elderly Patients: A Multicenter Randomized Controlled Trial. J Bone Joint Surg Am. 2019 Jan 16;101(2):136-144. doi: 10.2106/JBJS.18.00316.

Reference Type BACKGROUND
PMID: 30653043 (View on PubMed)

Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The Harris hip score: Do ceiling effects limit its usefulness in orthopedics? Acta Orthop. 2010 Dec;81(6):703-7. doi: 10.3109/17453674.2010.537808.

Reference Type BACKGROUND
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Gjertsen JE, Fevang JM, Matre K, Vinje T, Engesaeter LB. Clinical outcome after undisplaced femoral neck fractures. Acta Orthop. 2011 Jun;82(3):268-74. doi: 10.3109/17453674.2011.588857.

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Zlowodzki M, Brink O, Switzer J, Wingerter S, Woodall J Jr, Petrisor BA, Kregor PJ, Bruinsma DR, Bhandari M. The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study. J Bone Joint Surg Br. 2008 Nov;90(11):1487-94. doi: 10.1302/0301-620X.90B11.20582.

Reference Type BACKGROUND
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Sikand M, Wenn R, Moran CG. Mortality following surgery for undisplaced intracapsular hip fractures. Injury. 2004 Oct;35(10):1015-9. doi: 10.1016/j.injury.2004.01.004.

Reference Type BACKGROUND
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Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. BMJ. 2015 May 8;350:h2147. doi: 10.1136/bmj.h2147. No abstract available.

Reference Type BACKGROUND
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Kristensen PK, Thillemann TM, Soballe K, Johnsen SP. Are process performance measures associated with clinical outcomes among patients with hip fractures? A population-based cohort study. Int J Qual Health Care. 2016 Dec 1;28(6):698-708. doi: 10.1093/intqhc/mzw093.

Reference Type BACKGROUND
PMID: 27591269 (View on PubMed)

de Morton NA, Harding KE, Taylor NF, Harrison G. Validity of the de Morton Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation. Disabil Rehabil. 2013 Feb;35(4):325-33. doi: 10.3109/09638288.2012.705220. Epub 2012 Aug 16.

Reference Type BACKGROUND
PMID: 22897700 (View on PubMed)

de Morton NA, Berlowitz DJ, Keating JL. A systematic review of mobility instruments and their measurement properties for older acute medical patients. Health Qual Life Outcomes. 2008 Jun 5;6:44. doi: 10.1186/1477-7525-6-44.

Reference Type BACKGROUND
PMID: 18533045 (View on PubMed)

Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993 Sep;75(5):797-8. doi: 10.1302/0301-620X.75B5.8376443.

Reference Type BACKGROUND
PMID: 8376443 (View on PubMed)

Kristensen MT, Foss NB, Kehlet H. [Timed Up and Go and New Mobility Score as predictors of function six months after hip fracture]. Ugeskr Laeger. 2005 Aug 29;167(35):3297-300. Danish.

Reference Type BACKGROUND
PMID: 16138973 (View on PubMed)

Kristensen MT, Bandholm T, Foss NB, Ekdahl C, Kehlet H. High inter-tester reliability of the new mobility score in patients with hip fracture. J Rehabil Med. 2008 Jul;40(7):589-91. doi: 10.2340/16501977-0217.

Reference Type BACKGROUND
PMID: 18758678 (View on PubMed)

Pedersen TJ, Lauritsen JM. Routine functional assessment for hip fracture patients. Acta Orthop. 2016 Aug;87(4):374-9. doi: 10.1080/17453674.2016.1197534. Epub 2016 Jun 22.

Reference Type BACKGROUND
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Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, Oxman AD, Moher D; CONSORT group; Pragmatic Trials in Healthcare (Practihc) group. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008 Nov 11;337:a2390. doi: 10.1136/bmj.a2390.

Reference Type BACKGROUND
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Palm H, Gosvig K, Krasheninnikoff M, Jacobsen S, Gebuhr P. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year. Acta Orthop. 2009 Jun;80(3):303-7. doi: 10.3109/17453670902967281.

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Schmidt M, Pedersen L, Sorensen HT. The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol. 2014 Aug;29(8):541-9. doi: 10.1007/s10654-014-9930-3. Epub 2014 Jun 26.

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Kristensen MT. Hip fractures - Functional assessments and factors influencing in-hospital outcome, a physiotherapeutic perspective. Faculty of Medicine: Lund University; 2010.

Reference Type BACKGROUND

Steihaug OM, Gjesdal CG, Bogen B, Kristoffersen MH, Lien G, Hufthammer KO, Ranhoff AH. Does sarcopenia predict change in mobility after hip fracture? a multicenter observational study with one-year follow-up. BMC Geriatr. 2018 Mar 5;18(1):65. doi: 10.1186/s12877-018-0755-x.

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The Danish Interdisciplinary Registry for Hip Fracture. National Annual Report for 2017. The Danish Healthcare Service; 2017 15.05.2017.

Reference Type BACKGROUND

Viberg B, Kold S, Brink O, Larsen MS, Hare KB, Palm H; SENSE collaborators. Is arthroplaSty bEtter than interNal fixation for undiSplaced femoral nEck fracture? A national pragmatic RCT: the SENSE trial. BMJ Open. 2020 Oct 10;10(10):e038442. doi: 10.1136/bmjopen-2020-038442.

Reference Type DERIVED
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Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Other Identifiers

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S-20180036

Identifier Type: -

Identifier Source: org_study_id

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